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Sports medicine

Sports medicine Perspective 3 November 2025 Free

Mild traumatic brain injury and concussion and persisting post‐concussion symptoms: new guidelines to support evidence‐based assessment and management in Australia and Aotearoa New Zealand

Research into the implementation of the guidelines on concussion and persisting post-concussion in the context of the differing Australian and Aotearoa New Zealand geographical areas will be important to ensure adequate uptake

Karen M Barlow · Jennie L Ponsford · Alice Theodom · Gill Cowen · Gavin A Davis · Vicki Anderson · Franz E Babl · David Cole · Jennifer Cullen · Stuart R Dalziel · Melinda Fitzgerald · Howard Flavell · Caroline Yates · Rebecca Kimble · John H Olver · Rhonda Orr · Mark Ralfe · Michael Rose · Nick Rushworth · Julia Treleaven · Gary Browne · Nathan Delang · Sarah Harris · Gary Mitchell · Sean Tweedy

Cardiovascular diseases Narrative review 5 July 2021 Free

Persistent pathology of the patent foramen ovale: a review of the literature

A patent foramen ovale (PFO) is an interatrial shunt, with a prevalence of 20–34% in the general population. While most people do not have secondary manifestations of a PFO, some reported sequelae include ischaemic stroke, migraine, platypnoea–orthodeoxia syndrome and decompression illness. Furthermore, in some cases, PFO closure should be considered for patients before neurosurgery and for patients with concomitant carcinoid syndrome. Recent trials support PFO closure for ischaemic stroke patients with high risk PFOs and absence of other identified stroke mechanisms. While PFOs can be associated with migraine with auras, with some patients reporting symptomatic improvement after closure, the evidence from randomised controlled trials is less clear in supporting the use of PFO closure for migraine treatment. PFO closure for other indications such as platypnoea–orthodeoxia syndrome, decompression illness and paradoxical embolism are based largely on case series with good clinical outcomes. PFO closure can be performed as a day surgical intervention with high procedural success and low risk of complications.

Kenneth K Cho · Shaun Khanna · Phillip Lo · Daniel Cheng · David Roy

Mja2 51141
Emergency medicine Research letters 30 September 2019 Free

Clinically important sport‐related traumatic brain injuries in children

The proportion of head injuries that is acutely clinically significant is greater for recreational sports than for contact sports associated with risk of concussion

Nitaa Eapen · Gavin A Davis · Meredith L Borland · Natalie Phillips · Ed Oakley · Stephen Hearps · Amit Kochar · Sarah Dalton · John Cheek · Jeremy Furyk · Mark D Lyttle · Silvia Bressan · Louise Crowe · Stuart Dalziel · Emma Tavender · Franz E Babl

Mja2 50311
Cancer Letter 14 January 2019 Free

Clinical Oncology Society of Australia position statement on exercise in cancer care

To the Editor: We write to express our concerns regarding the Clinical Oncology Society of Australia (COSA) position statement on exercise in cancer care published in the MJA1 and promoted in media outlets as a “world‐first” position statement that calls for exercise to be prescribed for all patients with cancer.2 The guideline replicates those first published in Australia in 20093 and in the United States in 20104 as well as by other organisations,5 and are the same as public health recommendations for healthy adults.6 Given the array of cancers, disease stages and treatments and their combinations, it is somewhat surprising that the same general guideline is being prescribed for all patients with cancer and is not differentiated from that for healthy adults — especially, given patient health and comorbidity status and the challenges that a cancer diagnosis and treatment entail. Research in exercise oncology has progressed over the past 9 years, and more targeted and tailored guidelines reflecting the developing evidence base are now required for implementation in this population. Moreover, the majority of patients with cancer are unable to meet the COSA recommendation of at least 150 minutes of aerobic exercise and two to three resistance exercise sessions due to time availability and physical, psychological and financial capacity as well as access, let alone the level of care required for those with advanced disease. It is significant that the COSA recommendation has not been refined through clinical trials in patients with cancer and has the potential to create considerable angst for the patient and raise concerns for clinicians, who know that their patients may not be able to achieve such goals. Moreover, we highlight that there is minimal financial support for patients with cancer to undertake ongoing exercise, making the COSA recommendation somewhat superfluous. When exercise is prescribed, it must be evidenced‐based and tailored to specifically ameliorate adverse health problems, while recognising that certain modes and dosages of exercise may be detrimental. We agree that there is considerable potential for exercise medicine in the management of cancer; however, a more considered approach needs to be implemented rather than the generic exercise recommendations of the COSA statement.

Robert U Newton · Dennis R Taaffe · Daniel A Galvao

Neurology Letters 6 August 2018 Free

Traumatic cricket-related fatalities in Australia: a historical review of media reports

To the Editor:I read with interest the article by Brukner and colleagues1 on traumatic cricket-related fatalities in Australia, which describes two autopsy-confirmed deaths due to subarachnoid haemorrhage following vertebral artery dissection, with a further 11 deaths suspected to be secondary to this condition. Two recent articles described a total of 230 cases of carotid or vertebral artery dissection temporally related to 45 different sports or recreational activities.2,3 The majority of episodes of arterial dissection were related to non-contact sports, including jogging, walking, swimming, golf, basketball, tennis and scuba diving. The mean age of patients was 35 years. The mechanism of non-traumatic dissection is thought to relate to shearing stress on the arterial wall with sudden neck rotation. Thus arterial dissection in golfers affected the right side in 11 of 14 patients (79%), and involved the posterior circulation in 12 of 14 patients (86%).4 Controversy regarding the association between neck manipulation and arterial dissection persists, although a retrospective case–control study found an odds ratio of 12.8 for prior neck manual therapy in individuals aged 55 years or less presenting with craniocervical arterial dissection.5 Arterial dissection may also occur spontaneously, the risk being increased in the setting of systemic lupus erythematosus, other connective tissue disorders, migraine and in the postpartum period. It is important that health professionals recognise that arterial dissection may occur spontaneously or as a result of non-contact sports and activities, and that persons of any age presenting with symptoms suggestive of anterior or posterior circulation ischaemia require urgent review and neuroimaging.

Adam Morton

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